Prior authorization (PA) for medical care affects timely patient treatment access. Prior authorization processes, during which payers (Health Plans) determine if they will reimburse providers for a certain treatment before it can be administered. PAs are necessary for Health Plan cost containment.
These PAs are a critical part of care and should be handled fast and efficiently. Yet, Health Plans have serious problems keeping backlogs under control with their current staff and contend that Prior Authorization is burdensome, often hindering timely access to treatment, according to the AMA. "Utilization management (UM) programs, such as prior authorization, can create significant barriers for patients by delaying the state of continuation of necessary treatment and negatively affecting patient health outcomes," the group said.
What can Health Plans do to streamline the process? It takes added time (and money) to find, interview, hire, on-board, train, and retain adequate numbers of Senior Level nurses who are state-licensed, U.S. based, understand the Health Plan Business, have prior experience with clinical reviews, and will stay employed for a minimum of 2 years.
The proven, fast, cost-efficient solution: Contract for experienced Health Plan PA nurses familiar with UM procedures, have a clear understanding of business practices and workflow, and possess the software expertise. These contract employees can be a real relief for Health Plans.
Health Plans are on the lookout for Just-in-Time (JIT) nurses like these who can step in quickly and be engaged, on-boarded and productive within 2-5 business days. Having been "in the trenches" serving as nurses and claims managers for more than two decades, Blue Eagle Consulting's (BEC) top notch team is uniquely positioned to assist Health Plans through Prior Approval bottlenecks. Our PA services are time-tested, proven and available through remote IT access using our PA Review nurses’ existing PC’s (each has their own)," elucidates Mark Griffin, President of Blue Eagle Consulting.
Griffin continues, “All Review nurses are senior level Health Plan nurses with years of PA Review experience. They are matched to a client’s request based on licensing requirements and have completed screening and background checks per the client’s criteria. On-going support, problem resolution and re-training is provided by BEC’s Project Manager with each Review Nurse and coordinated or reported to the designated client contact.”
A Health Plan Prior Approval White Paper citing PA clinical review capabilities and 95% error-free completion rates is available for download or by calling 1 (866) 981-1095. The report features proven PA solutions, deliverables, results, and case studies with new and existing state Medicaid and Medicare Plans with 25,000 up to 400,000 members.
Blue Eagle Consulting has been successfully providing Health Plan nurses and IT consulting resources for 15 years. The organization developed and perfected it’s “PRN” (PRN stands for the Latin phrase “pro re nata” which means "as the situation demands") model over the past few years, now having completed its fourth major engagement by Health Plan Care Management Departments to address PA issues in Medicaid/Medicare business lines utilizing an established pool of over 40 PA Review nurses.
Blue Eagle Consulting looks forward to forging a low effort, low risk, high return partnership with Health Plan clients with an emphasis on consulting and contract services. When you have a mountain to move or a fire to put out, especially when it comes to Prior Authorization, just having one more body to throw into the fray isn’t enough. You’re looking for a team of confident, competent, experienced PA nurses who are ready and waiting to get the job done…FAST.
BEC takes pride in the ability to source and place the finest nurses available and get them productive on your Health Plan project really quickly. We’d love to have a shot at helping make your PA backlog a thing of the past. If you’d like to start a conversation and request your free, no obligation Health Plan Prior Approval White Paper, just give us a call at 1 (866) 981-1095 or click here.